Health Assessment - For newcomers

  • Please go to the LOGIN button in the upper right hand corner of this page.
  • Log in with the user name and password you received when you made your first appointment.
  • Go to the purple pod on your personal dashboard and click on Health Assessments.
  • Follow the instructions to fill out and submit your intake forms online.
  • Call 802-387-2345 if you have any questions or problems doing this. Thanks!

Medical History and Current Health Information

Personal health information requested at HeartSong is more comprehensive than in other primary care settings. This is because mind, body, emotion, and spirit are considered as an integral whole at HeartSong.  Information about past medical care is collected in order to make your transition from one health care provider to another as seamless as possible.  The more you share and the more candid you are, the more precisely your treatment plan can be personalized. Feel free to skip questions that you do not want to answer, or would prefer to discuss in person. 

Signature Pages

You will be asked to complete and sign various forms at your first visit. To expedite this process, you can print and sign them ahead of time, and bring them with you when you come.

1. Registration: Personal contact and insurance information, plus an acknowledgement of our financial policy.

2. Informed Consent Acknowledgement: Acknowledgement of your understanding of HeartSong's informed consent policy.

3. HIPAA Acknowledgement 2013: Your acknowledgement of having been given access to HeartSong's 2013 privacy notice.

4. Non-Covered-Service Waiver: Your acknowledgement of your responsibility to pay for services that are not covered by insurance. Go to Your Finances for more details.

Past Medical Records

In order to optimize the continuity of the health care that you receive, it is important for HeartSong to have your past medical records. If do not have copies, please complete the Medical Information Release form to send to your previous provider(s). You can send it yourself or have it faxed from HeartSong.

Psychiatric Care Coordination

If you are under care with a psychologist or psychiatrist and would like your HeartSong doctor and your mental health clinician to coordinate your care, please complete the Psychiatric Information Release form. Bring one copy to HeartSong and give another to your mental health provider.

Advance Directives

Advance Directives are documents that guide your medical care when you are incapable of personally communicating what you want. By completing these forms, you will be able to receive the care that you want under any circumstances. For more information, contact the Vermont Ethics Network at 802-828-2909 or go to

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for a telehealth consultation

Directions to HeartSong


Your visits

During your visits, you will have time to:

  • Discuss the reason for your visit in depth
  • Learn about diagnosis & your prognosis
  • Hear about different treatment options
  • Collaborate with your doctor to create a personal treatment plan
  • Ask questions
  • Obtain referrals to specialists if needed.
  • Receive health education, personal counseling & self-care guidance.


It can be very helpful to clarify your expectations for your visit before you see a new doctor. Take time to prepare a list of topics you would like to talk about.